Provider Demographics
NPI:1740059682
Name:FAMILY SERVICE AGENCY
Entity type:Organization
Organization Name:FAMILY SERVICE AGENCY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SYSTEMS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SORAIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DURAZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-863-1862
Mailing Address - Street 1:PO BOX 86537
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85754-6537
Mailing Address - Country:US
Mailing Address - Phone:520-721-1887
Mailing Address - Fax:520-721-0069
Practice Address - Street 1:4337 W INDIAN SCHOOL RD STE 109-110
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-2982
Practice Address - Country:US
Practice Address - Phone:602-233-9401
Practice Address - Fax:602-233-1302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZOTC8397OtherSTATE OF ARIZONA